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In this paper it is argued that when a patient is confronted with his analyst's pregnancy, this fact intrudes itself forcibly and painfully on his consciousness and on his treatment. He is thus confronted unequivocally with some of the most important facts of life, with an immediacy and intensity that is difficult to escape and to negotiate. There is considerable disruption in the established equilibrium and the pregnancy may constitute a psychic crisis for the patient. At the same time, the pre-existing object relationships come into focus more clearly as do the predominant dynamics surrounding the patient's apprehension of some of the most fundamental facts of life.
The author describes the analytic process as it unfolds with a male patient, throughout the period of her pregnancy and after her return from a 5-month break. For him, the discovery of the pregnancy constituted a crisis, and he responded with vigorous attempts to re-establish the status quo. A chronic impasse developed where the predominant object relations seen prior to the pregnancy became intensified and fixed. Potentially lively feelings and fantasies were held in a frozen state. The patient apparently had to remove himself to an even greater distance than previously, in order to protect himself from the actual disruption in the setting and from an awareness of its meaning to him.
Before 1966, the topic of the analyst's pregnancy and its effect on treatment had not been addressed specifically in the literature. Only a single paper by Hannet in 1949 had discussed some of the issues related to an analyst's
miscarriage. Subsequent authors have speculated on possible reasons for this unusual silence. One suggestion is that deep-seated taboos about mentioning it may be related to a fear of the evil eye. In other words, there may be a shared fantasy that if the pregnancy can go relatively unnoticed or uncommented upon, it may be protected from the destructive effects of envy. Moreover, the conscious and unconscious links between birth and death may also need to be avoided.